Early Repolarization

[david2951]

  Hi,
     I am a young male athlete with no prior medical history. I have always experienced infrequent palpitations, such as skipped beats, or, more rarely, little racing flutters of seemingly irregular beats. I had some work-up done recently to make sure I don't have any serious problems. My echo shows no structural issues, and most of my EKG's that I've had over the course of my life have been pretty normal. There was, however, one EKG that came back with early repolarization. I know that being young, male, and a fit runner makes it more likely for me to have early repolarization, and that in such cases it is usually benign, but I have read some more recent research that says it might be a sign of increased risk of sudden cardiac arrest from VF. I have read that this would be more likely if I showed the early repolarization in leads II, III, or AVF. (the inferior leads). I guess the lateral leads might also show this "malignant" pattern as well. It seems that if you have descending or horizontal (as opposed to ascending) ST elevation in leads where early repolarization is present this is a bad sign (especially in the inferior and lateral leads). Now, while most of my other numerous EKG's have never really shown any of this, I am a little concerned as to whether this particular EKG is demonstrating something that could be leaving more susceptible to sudden cardiac death. I wouldn't worry, but I guess the fact that I sometimes feel palpitations makes me wonder if it isn't just PACs, PVCs, and some form of mild SVT that are causing my symptoms as my EP doctor and cardiologist seem to think. I am having a difficult time discerning which leads I actually have early repolarization in (presence of J waves and/or J point elevation above 0.1mV).

Do any doctors have any advice on whether or not I should be alarmed by this EKG finding? Also, would any doctor be willing to look at this EKG via email and tell me which leads have early repolarization?

[CCFHeartMD14]

Dear David,

First of all you should repeat your ecg.  You can’t make diagnosis of early repolarization (ER) based on single ecg (especially if you had other which did not show ER). There are different reasons why one particular can resemble ER pattern and unless results of this single ecg are reproducible you don’t have ER.  
ER is a common finding (occurs in 2-5% of population). It was linked in few studies with increased risk of  sudden cardiac death but the significance and implications of this observation are not clear. Indeed the risk appears to be highest early repolarization in inferior leads. Even if you have ER, unless you had episodes of unexplained syncope or proven complex ventricular arrhythmia the implications of ER finding are not clear.
If you indeed have occasional palpitations, 30 days event monitoring (you would need to carry small device all the time for 30 days and activate recording when you feel palpitation) could help to assess the arrhythmia risk in your case. It is also possible that even if you have  early repolarization in ecg, your palpitations are benign (as they most often  are ) and not related to early repolarization syndrome.
I would recommend finding cardiac electrophysiologist you like and trust and follow his recommendation. However first of all repeat your ecg and consider what I mentioned (the possibility that you don’t have ER)
Best wishes

[david2951]

Thanks for your answer.
    -So, basically you are saying that if I really had early repolarization it most likely would always be on the EKG?.... I have had several done over the years for sport screenings and recently had a 24 hour Holter study and no early repolarization was ever shown. It was just on this one EKG that was taken in the emergency room last summer when I became very dehydrated on after 10 miles in very hot conditions (I had lost about 9 pounds of water weight). I didn't pass out then, but I lost my vision and hearing for a few seconds which is why I went to the ER that day. Could dehydration cause some form of STE that resembles early repolarization?
        -I've actually just gotten an EP and I do trust him, so I feel confident that he is doing all the right things for me. I am actually wearing a 30 day monitor as we speak, and I actually felt some palpitation symptoms last night and I recorded it, so I guess I will find out what was causing at least that one little episode. I have no family history whatsoever of young cardiac death, and have never passed out. They have also ruled out things like Long QT and Brugada from looking at my EKG's.
     -I am just a naturally nervous person, and although I trust my doctor, I was just looking for second opinions regarding the whole early repolarization deal, because it seems to be a new finding and just wanted to make sure that my EP wasn't perhaps overlooking something that would prove to most likely be really serious if it was there, but it does not seem that that is what you are indicated, so I thank you for the reassurance.